Physical Therapy ICU Considerations Flashcards
ICU patients
Patientswithacuteexacerbationof respiratory failure
HR normal
60-100
RR normal
12-20
CVP normal
0-8 mm Hg
ICU before treatment
- Review medical chart prior to treatment to be alert to any recent changes in status
- Check with nursing prior to treatment
ICU during treatment
Check vitals on monitor, record serially throughout intervention
ICU after treatment
Communicate with the rest of the team
someone on a ventilator - can they get PT
yes
why is PT good for someone on a ventilator
prevent the negative things of
* Immobility
* Respiratory muscle weakness
Cardiovascular
* Decreased ability to perform aerobic work
* Orthostatic hypotension-decreased circulating blood volume,
decreased tone of vasculature
* DVT and PE
ICU impacts on MSK system
Contractures
atrophy
decreased strength
ICU psychosis
delirium from environmental and medical disturbances
Splinting needs
foot drop, positioning
caution with what level of FiO2
caution with FI02 > 60
can a pt on particle ventilation be able to participate in breathing exercises
yes
oxygen demand and PT timing
Time physical therapy intervention so that oxygen demand is not increased by PT intervention at a time when oxygen demand is elevated from weaning process
what is the John-Hopkins Highest Level of Mobility (JH-HLM)
common lang tool
performance measure of the patient’s highest level of mobility achieved
proning and alveolar area
improve v/q ratio by allowing alveoli improved available surface area and inflation
at what time is proning beneficial
ATLEAST 16 hours out of 24 in prone
peep that is contraindicated for PT
greater than 10 cm H2O
contraindicated for PT - O2 level
Consistent O2 Saturations less than 92%
desaturations
Drops in blood oxygen level
contraindicated for PT - position chnages
desaturations with positional changes during nursing care
contraindicated for PT - ph level
Severe Acidosis with pH less than 7.30
yellow sign
Potential risk and consequences of an adverse event are higher than green but may be outweighed by the potential benefits of mobilization.
The precautions or consideration should be given to doing so gradually and cautiously.
red sign
Significant potential risk or consequences of an adverse event
Active mobilization should not occur unless specifically authorized by the treating intensive care specialist in consultation with the senior physical therapist and senior nursing staff.
